Intensive Insulin Therapy for MI Patients Questioned
the MPR take:
In the Swedish Diabetes Mellitus Insulin Glucose Infusion in Acute Myocardial Infarction 1 (DIGAMI 1) trial from 1990–1993, 620 myocardial infarction (MI) patients with glucose levels of >11mmol/L were randomized to receive either intensive insulin treatment or conventional therapy. Patients receiving the intensive insulin treatment had improved survival compared to those receiving conventional treatment; a 20-year follow-up study published in The Lancet Diabetes & Endocrinology, showed intensive insulin treatment patients had an average 2.3 year increase in survival (median survival 7.0 years vs. 4.7 years, HR 0.83, CI 0.70–0.98, p=0.27). However, some critics argue that recent studies have found no benefit for intensive insulin treatment over conventional treatment due to patients having lower HbA1c levels in trials post-DIGAMI 1 and therapies such as ACE inhibitors and statins now being available.
A trial that started back in 1990 continues to demonstrate a significant mortality advantage for intensive insulin therapy in heart attack (MI) patients. Although earlier trials demonstrated the benefits of intensive glucose control in type 2 diabetics, more recent trials have found no benefit ...
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